title: Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients.
abstract: OBJECTIVE
  To present the results of stereotactic body radiotherapy (SBRT) for medically inoperable patients with Stage I non-small-cell lung cancer (NSCLC) and contrast outcomes in patients with and without a pathologic diagnosis.
  
  
  METHODS
  Between December 2004 and October 2008, 108 patients (114 tumors) underwent treatment according to the prospective research ethics board-approved SBRT protocols at our cancer center. Of the 108 patients, 88 (81.5%) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography. A pathologic diagnosis was unavailable for 33 (28.9%) of the 114 lesions. The SBRT schedules included 48 Gy in 4 fractions or 54-60 Gy in 3 fractions for peripheral lesions and 50-60 Gy in 8-10 fractions for central lesions. Toxicity and radiologic response were assessed at the 3-6-month follow-up visits using conventional criteria.
  
  
  RESULTS
  The mean tumor diameter was 2.4-cm (range, 0.9-5.7). The median follow-up was 19.1 months (range, 1-55.7). The estimated local control rate at 1 and 4 years was 92% (95% confidence interval [CI], 86-97%) and 89% (95% CI, 81-96%). The cause-specific survival rate at 1 and 4 years was 92% (95% CI, 87-98%) and 77% (95% CI, 64-89%), respectively. No statistically significant difference was found in the local, regional, and distant control between patients with and without pathologically confirmed NSCLC. The most common acute toxicity was Grade 1 or 2 fatigue (53 of 108 patients). No toxicities of Grade 4 or greater were identified.
  
  
  CONCLUSIONS
  Lung SBRT for early-stage NSCLC resulted in excellent local control and cause-specific survival with minimal toxicity. The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis. SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC.
authors.affiliation: Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada. mojgan.taremi@rmp.uhn.on.ca
authors.forename: Mojgan
authors.initials: M
authors.lastname: Taremi
authors.forename: Andrew
authors.initials: A
authors.lastname: Hope
authors.forename: Max
authors.initials: M
authors.lastname: Dahele
authors.forename: Shannon
authors.initials: S
authors.lastname: Pearson
authors.forename: Sharon
authors.initials: S
authors.lastname: Fung
authors.forename: Thomas
authors.initials: T
authors.lastname: Purdie
authors.forename: Anthony
authors.initials: A
authors.lastname: Brade
authors.forename: John
authors.initials: J
authors.lastname: Cho
authors.forename: Alexander
authors.initials: A
authors.lastname: Sun
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bissonnette
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009864:Ontario; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011832:Radiation Injuries / Q000473:pathology; D019275:Radiopharmaceuticals; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18